Testing a Couple-based Program for Alcohol Risk Reduction in the National Guard

描述(由申请者提供)：军队中酗酒的比率目前徘徊在47%，构成了一种“公共健康危机”(国际移民组织，2012年)，几乎没有基于证据的预防计划来阻止这一趋势。军人中的危险饮酒直接损害心理健康和军事准备，也是几个重叠问题的风险因素，包括酒精使用障碍(AUD)、使用其他药物、抑郁、自杀和关系冲突。根据PAR-12-279，这项R34名为“在国民警卫队中测试基于夫妇的酒精风险降低计划”，旨在开发和测试一种有指示的二级预防干预措施，以利用婚姻支持和促进健康的努力，如加强关系和解决问题，以取代使用酒精来应对重返社会的挑战。高达81%的军人已婚或处于稳定的关系中，将以夫妇为基础的预防计划纳入兵役环境已被确定为一种前景看好但未得到充分利用的健康促进战略。国民警卫队(NG)成员及其家人是一个特殊需求群体，因为酗酒、精神健康和家庭问题的比率很高，再加上地理上的挑战，限制了获得军事卫生保健支持系统的机会。拟议的“指示二级预防”项目针对的是尚未发展为AUD的危险饮酒NG成员。第一个目标是将我们的有效酒精行为夫妇疗法(ABCT)手册修改为一个简短的指示二级预防方案，称为酒精行为夫妇预防(ABCP)，可供军事环境中的专业人员或辅助专业人员进行面对面或远程保健。新的ABCP的目标是让夫妇们学会共同努力，将危险饮酒降至最低，以便开始有效地解决退役军人中经常存在的其他问题。目的2是现场测试6对夫妇的面对面递送平台(ABCP_P)，改进远程医疗递送平台(ABCP_T)，以6对新夫妇现场测试改进后的方案。目标3是进行一项小型随机对照试验，每种情况下有22对夫妇：(1)“一如既往的预防”(PAU)，包括年度简报和目前在NG实施的有限监测系统；(2)PAU+ABCP_P；(3)PAU+ABCP_T。主要结果变量包括饮酒、婚姻状况和应对技能。健康促进行为变化的候选中介，包括对饮酒的态度和信念将被跟踪。该项目符合国际移民组织(2013年)的建议；其目的是通过一项以证据为基础的减少风险议定书，填补军人中危险饮酒和相关风险预防战略的空白，以支持整体部队准备工作，同时加强家庭单位。此外，它还包括一个远程医疗交付平台，以应对地理挑战和降低武装部队获得服务的障碍。

DESCRIPTION (provided by applicant): Rates of binge drinking in the military currently hover at 47% and constitute a "public health crisis" (IOM, 2012), with few evidence-based prevention programs in place to stem the tide. Hazardous drinking among service members is directly detrimental to psychological fitness and military readiness, and is also a risk factor for several overlapping problems, including alcohol use disorder (AUD), use of other drugs, depression, suicide, and relationship conflict. This R34, "Testing A Couple-based Program for Alcohol Risk Reduction in the National Guard," in line with PAR-12-279, aims to develop and test an indicated, secondary prevention intervention to harness marital support and health promoting endeavors such as relationship enhancement and problem solving to replace use of alcohol to cope with reintegration challenges. Up to 81% of military members are married or in a committed relationship and the integration of couple-based prevention programs into military service settings has been identified as a promising but underutilized health promotion strategy. National Guard (NG) members and their families are a special needs population due to high rates of heavy drinking, mental health, and family problems, paired with geographic challenges that limit access to military heath care support systems. The proposed "indicated secondary prevention" project targets hazardous drinking NG members who have not yet developed AUD. Aim 1 is to modify our efficacious Alcohol Behavioral Couple Therapy (ABCT) manual into a brief indicated secondary prevention protocol called Alcohol Behavioral Couple Prevention (ABCP), available for in-person or telehealth delivery by professionals or paraprofessionals in military settings. The goal of the new ABCP is for couples to learn to work together to minimize hazardous drinking in order to then begin to effectively address other problems often present among returning service members. Aim 2 is to field test an in-person delivery platform of the protocol (ABCP_P) with 6 couples, refine, and then field test a telehealth delivery platform (ABCP_T) for the refined protocol with 6 new couples. Aim 3 is to conduct a small randomized controlled trial with 22 couples in each condition: (1) "Prevention as usual" (PAU) which includes annual briefings and a limited monitoring system currently in place in the NG; (2) PAU plus ABCP_P, and (3) PAU plus ABCP_T. Primary outcome variables include alcohol use, marital functioning and coping skills. Candidate mediators of health promotion behavior change, including attitudes and beliefs about drinking will be tracked. This project is in accord with IOM (2013) recommendations; it aims to fill a gap in prevention strategies for hazardous drinking and associated risks among service members, with an evidence-based risk reduction protocol to support overall force readiness while strengthening the family unit. Further, it includes a teleheath delivery platform to address geographic challenges and lower barriers to accessible services for the armed forces.